Disseminated herpes zoster on a child with systemic lupus erythematosus and lupus nephritis

Abstract

Introduction: Disseminated herpes zoster (DHZ) is a complication of herpes zoster (HZ) associated with an immunocompromised state. Immunocompromised conditions in systemic lupus erythematosus (SLE) and lupus nephritis increase the incidence of DHZ. Case: A 14-year-old girl was consulted with a complaint of painful reddish blisters for the previous 4 days. At first, blisters only appeared on the right leg, then multiplied and spread throughout the body. The patient had been diagnosed with SLE since 3 months and 2 months later also diagnosed with lupus nephritis. The patient received methylprednisolone pulse dose 1 g for 3 days, then maintenance dose 1×80 mg every 2 days for 2 weeks before blisters appeared. Dermatological examination of the facial region, anterior and posterior trunk, gluteus, superior limb dextra and sinistra, dorsum manus, cruris dextra, femur dextra lateral and plantar pedis presented vesicles with an erythematous base, and some other confluent vesicles became bullae, well defined, with an irregular border, varied in size and shape. An investigation by Tzanck smears in bullae and vesicles showed polymorphonuclear cells (PMN) and multinucleated giant cells (MGC). Laboratory tests showed anemia, neutrophilia, and lymphopenia. The patient was diagnosed as HZD. The patient received oral acyclovir 5×800mg for 10 days and obtained clinical improvement. Conclusion: Although the onset of HZ in children is less common, it may occur in children with SLE comorbidity. Complications of DHZ in SLE patients may be due to immunological abnormalities, lymphopenia conditions, and immunosuppression therapy with high-dose glucocorticoids (GC). In addition, the incidence of both HZ and DHZ increases in lupus nephritis patients compared with SLE.